Is obesity the next tobacco?

As I was reading Mary Meeker's 2013 Internet Trends report, I came across this healthcare statistic:



Oh, Behave

While we've addressed the impact of behavior on health in a prior post, this statistic is still stunning. Simple behaviors are behind so much of our $2 trillion healthcare industry. Intrigued, I traced this particular statistic back to the original New England Journal of Medicine article in which it appeared.  The article highlights that smoking and obesity represent the bulk of bad behavior behind the stat:

source: New England Journal of Medicine


The Success of Smoking Cessation

The authors go on to illustrate the public health successes related to smoking cessation. Over a 50-year period from 1955 to 2005, smoking declined among American men from 57% to 23%. In 1964, the surgeon general promoted the dangers of smoking and its link to lung cancer. This report was followed by a growing corpus of scientific evidence that included details of the risks of second hand smoke. Laws and regulations followed, which limited or prevented smoking in public places. 

The authors suggest that we may be reaching a smoking tipping point, where the shrinking population of smokers is concentrated among the lower classes. While there are 44.5 million smokers in the United States, just 8% of those with postgraduate education smoke.


Same tactics with obesity?

Obesity has a scientific link to chronic disease, is driven by behavior, and, if corrected, can prevent many premature deaths. Can we just follow the model used with smoking cessation? Perhaps not. 

source: New England Journal of Medicine


A Sugar-free work environment?

Nonsmokers rallied against tobacco because of the "blast radius" of secondhand smoke. No such collateral damage occurs when someone is downing a Big Gulp of sugary soda. Smoking is also binary. You smoke or you don't. Obesity is a bit more nuanced. BMI isn't even a clear way to determine obesity. The body mass index (BMI) calculation is driven by height and weight and misclassifies people who have large muscle mass, including some otherwise lean athletes. Tobacco products are addictive. Is food addictive? Maybe. But in the same way that nicotine is? The food industry is less concentrated than is the tobacco industry and is therefore less vulnerable to litigation. While food advertising targeted at children has been criticized, it has not been subject to the same regulation as has tobacco advertising.



A new hope

Some progress with obesity reduction has been made at the policy level. More accurate labeling, including the inclusion of trans fat information, helps generate awareness among consumers and prompts some food manufacturers to change food composition. Some schools have banned sugary sodas and have made strides towards more nutritionally wholesome cafeteria offerings. But how can healthcare providers help?  Healthcare providers can certainly emphasize the health risks brought on by obesity when patients are in exam rooms or hospital beds. From a patient's perspective, this counsel has some value, but it is a fairly rare interaction. Considering how seldom one interacts with healthcare professionals throughout the course of a year, patients are mainly on their own when it comes to behavior change.


The question healthcare providers should ask is: what information and tools can we provide that will support a patient's day-to-day health management? The answer will help define a healthcare provider's patient engagement strategy.